Objective: Centralized exchanges of scientific materials existed by the late nineteenth century, but they did not include medical publications. North American medical leaders therefore formed an association of institutions to run their own exchange: the Medical Library Association (MLA). After providing background to the exchange concept and the importance of institutional members for MLA, this article examines archival MLA correspondence to consider the role of its Exchange in the association's professional development before the 1950s.

Results: MLA's membership policy admitted only libraries open to the medical profession with a large number of volumes. But the correspondence of the MLA Executive Committee reveals that the committee constantly adjusted the definition of library membership: personal, public, sectarian, commercial, allied science, and the then-termed "colored" medical school libraries all were denied membership.

Conclusion: Study of these decisions, using commercial and sectarian libraries as a focus, uncovers the primary justification for membership exclusions: a goal of operating a scientific exchange. Also, it shows that in this way, MLA shadowed policies and actions of the American Medical Association. Finally, the study suggests that the medical profession enforced its policies of exclusion through MLA, despite a proclaimed altruistic sharing of medical literature.

INTRODUCTION

By the late nineteenth century, formal exchanges of scientific materials operated among federal institutions, but they did not include medical publications. North American leaders in medicine therefore called for their own centralized exchange, to improve their libraries through weeding duplicates, completing runs of journals, and obtaining key books. Rather than establish physical quarters, such as a clearinghouse, they took a novel approach by creating a society to coordinate an exchange of publications: the Association of Medical Librarians, later called the Medical Library Association (MLA). As shown in Guardians of Medical Knowledge, a study of MLA's first fifty years, MLA was originally founded as a consortium of medical libraries to run an exchange for its institutional members and to pressure publishers to donate medical literature to them. Of the two earliest classes of membership, Library Membership took priority over Individual Membership, and MLA did not become an association in which individual memberships predominated until after World War II. In short, there were really two MLAs: one before 1946 and a very different one after 1946 [I].

Guardians of Medical Knowledge analyzed the dominant medical culture of the early MLA to understand its impact, through MLA, on development of what would eventually become two separate activities: a profession of medical librarianship and the scholarly field of history of medicine. However, as mentioned there, the extensive MLA archives for this period present many other topics for study, including the society's management of its own Exchange. Records reveal that the significance of the MLA Exchange to early library members, and their delegates, cannot be overstated. The membership application form emphasized MLA's goals for institutions, from the often repeated objective of the association ("fostering of medical libraries and the maintenance of an exchange of medical literature among its members") to the extra benefits for library members: "current files of a large number of the leading medical journals, society transactions, etc., which are sent free to library members of the Association by the publishers as soon as issued." It described the Exchange, whereby a "vast quantity of valuable medical journals... books, pamphlets, reports, etc.," was donated and distributed "absolutely free" to members, constituting "many thousand dollars' worth of medical literature" [2].

For decades, reports on MLA and its meetings declared that the "principal work of the Association" was the "carrying on of the Exchange," which was considered the "binding influence holding the Association together" and more: "the heart and life of this organization. …

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